School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Int J Cardiol. 2019 Feb 1;276:171-176. doi: 10.1016/j.ijcard.2018.10.094. Epub 2018 Oct 29.
An "obesity paradox" has been described in patients with chronic heart failure (CHF), obese patients having a better survival. Vasopressin is elevated in patients with CHF, and higher levels are associated with worsening severity of the disease. We aimed at evaluating the relationship between body mass index (BMI), obesity (BMI ≥30 kg/m), and vasopressin in patients with CHF, as well as the prognostic implications of vasopressin across the full spectrum of BMI values.
We included 1132 consecutive CHF patients referred to a multidisciplinary CHF unit. BMI and vasopressin levels were measured at baseline, and their association was evaluated using multivariable linear and logistic regression models. Death was evaluated after a median follow-up of 2.93 years and using Cox regression analyses.
Mean age was 73 years, 43% women, mean BMI 28 kg/m. Vasopressin levels were independently associated with all-cause death across the whole spectrum of BMI values, and were significantly lower in obese as compared to non-obese patients (median adjusted estimated levels of log-vasopressin in obese patients 2.57 [95% CI 1.5-3.67], in non-obese patients 3.16 [95% CI 2.11-4.23]; p < 0.001). Also, the higher the BMI, the lower the vasopressin levels, at least for patients with BMI <35 kg/m. Subgroup analyses stratifying by left ventricle ejection fraction and sensitivity analyses further adjusting for norepinephrin levels yielded similar findings.
Reduced levels of vasopressin may represent an independent mechanism in the survival paradox in obese patients with CHF. Studies including larger samples of patients BMI ≥35 kg/m are needed.
在慢性心力衰竭（CHF）患者中已经描述了一种“肥胖悖论”，即肥胖患者的生存率更高。血管加压素在 CHF 患者中升高，并且较高的水平与疾病严重程度的恶化相关。我们旨在评估 CHF 患者的体重指数（BMI）、肥胖（BMI≥30kg/m）和血管加压素之间的关系，以及血管加压素在 BMI 值全谱中的预后意义。
我们纳入了 1132 名连续就诊于多学科 CHF 病房的 CHF 患者。在基线时测量了 BMI 和血管加压素水平，并使用多变量线性和逻辑回归模型评估了它们之间的关联。在中位随访 2.93 年后，使用 Cox 回归分析评估了死亡情况。
平均年龄为 73 岁，43%为女性，平均 BMI 为 28kg/m。血管加压素水平与 BMI 全谱范围内的全因死亡独立相关，并且在肥胖患者中明显低于非肥胖患者（肥胖患者调整后中位估计的 log-血管加压素水平为 2.57 [95%CI 1.5-3.67]，非肥胖患者为 3.16 [95%CI 2.11-4.23]；p<0.001）。此外，BMI 越高，血管加压素水平越低，至少对于 BMI<35kg/m 的患者是如此。按左心室射血分数分层的亚组分析和进一步调整去甲肾上腺素水平的敏感性分析得出了类似的结果。
血管加压素水平降低可能代表了肥胖 CHF 患者生存悖论中的一个独立机制。需要纳入更多 BMI≥35kg/m 的患者样本的研究。
